Non-adherence among women enrolled in a contraceptive vaginal ring use study in Kisumu, Kenya, 2014-2015
# Background Given future potential use of vaginal rings to prevent HIV infection, we examined the association of contraceptive vaginal ring (CVR) non-adherence with user dissatisfaction, tolerability, demographic, and behavioral factors. # Methods In an open-label single-group study, sexually ac...
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| Format: | Article |
| Language: | English |
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Inishmore Laser Scientific Publishing Ltd
2018-09-01
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| Series: | Journal of Global Health Reports |
| Online Access: | https://doi.org/10.29392/joghr.2.e2018032 |
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| author | Eleanor McLellan-Lemal Roman Gvetadze Mitesh A Desai Esther M Makanga Yi Pan Richard E Haaland Angela N Holder Victor Mudhune Tiffany Williams Taraz Samandari |
| author_facet | Eleanor McLellan-Lemal Roman Gvetadze Mitesh A Desai Esther M Makanga Yi Pan Richard E Haaland Angela N Holder Victor Mudhune Tiffany Williams Taraz Samandari |
| author_sort | Eleanor McLellan-Lemal |
| collection | DOAJ |
| description | # Background
Given future potential use of vaginal rings to prevent HIV infection, we examined the association of contraceptive vaginal ring (CVR) non-adherence with user dissatisfaction, tolerability, demographic, and behavioral factors.
# Methods
In an open-label single-group study, sexually active women aged 18-34 years using oral or injectable hormonal contraception, conveniently sampled from general population, were assigned to 6-month use of a commercial CVR currently not licensed for use in Kenya. Non-adherence in any CVR cycle completed was assessed from: (1) self-report (not used for at least 1 day), and (2) pharmacy record (failure to timely receive a new CVR or return a used one). Additionally, non-adherence was assessed in a subset of participants by residual progestin and estrogen levels measured in returned CVRs.
# Results
Of 202 participants who underwent CVR insertion by a study clinician, 142 completed all 6 visits, 172 responded to questions about ring use, and 43 provided used CVRs from months 1, 3, and 6 for residual hormone analysis. Non-adherence was 14.0% (24/172) by self-report and 54.5% (110/202) by pharmacy record. Non-adherence by pharmacy record was significantly reduced among women with a salary-based income (prevalence ratio (PR) 0.71, 95% confidence interval (CI) (0.55-0.91)\] compared to women with income not salary-based or no income. Participants dissatisfied with CVR on ≥4 aspects (ambiguity of instructions, inconvenience of use, sensation, sexual discomfort, etc.) were more likely to report non-adherence (PR 2.69, 95% CI=(1.31-5.52)\] compared to those dissatisfied with ≤3 aspects. Non-adherence by residual hormone levels was identified in 46.5% (20/43) participants. Over time, this subset of participants showed increasing non-adherence (*P*=0.004). We found lack of agreement among the various measures of non-adherence.
# Conclusions
Economic empowerment interventions, especially those emphasizing partner-independent income options, and expanded education on CVR features may alleviate non-adherence. Addressing CVR dissatisfaction preemptively may also help mitigate non-adherence. |
| format | Article |
| id | doaj-art-d086cfb8eaf4477c82161dc622f1d997 |
| institution | DOAJ |
| issn | 2399-1623 |
| language | English |
| publishDate | 2018-09-01 |
| publisher | Inishmore Laser Scientific Publishing Ltd |
| record_format | Article |
| series | Journal of Global Health Reports |
| spelling | doaj-art-d086cfb8eaf4477c82161dc622f1d9972025-08-20T03:20:39ZengInishmore Laser Scientific Publishing LtdJournal of Global Health Reports2399-16232018-09-01210.29392/joghr.2.e2018032Non-adherence among women enrolled in a contraceptive vaginal ring use study in Kisumu, Kenya, 2014-2015Eleanor McLellan-LemalRoman GvetadzeMitesh A DesaiEsther M MakangaYi PanRichard E HaalandAngela N HolderVictor MudhuneTiffany WilliamsTaraz Samandari# Background Given future potential use of vaginal rings to prevent HIV infection, we examined the association of contraceptive vaginal ring (CVR) non-adherence with user dissatisfaction, tolerability, demographic, and behavioral factors. # Methods In an open-label single-group study, sexually active women aged 18-34 years using oral or injectable hormonal contraception, conveniently sampled from general population, were assigned to 6-month use of a commercial CVR currently not licensed for use in Kenya. Non-adherence in any CVR cycle completed was assessed from: (1) self-report (not used for at least 1 day), and (2) pharmacy record (failure to timely receive a new CVR or return a used one). Additionally, non-adherence was assessed in a subset of participants by residual progestin and estrogen levels measured in returned CVRs. # Results Of 202 participants who underwent CVR insertion by a study clinician, 142 completed all 6 visits, 172 responded to questions about ring use, and 43 provided used CVRs from months 1, 3, and 6 for residual hormone analysis. Non-adherence was 14.0% (24/172) by self-report and 54.5% (110/202) by pharmacy record. Non-adherence by pharmacy record was significantly reduced among women with a salary-based income (prevalence ratio (PR) 0.71, 95% confidence interval (CI) (0.55-0.91)\] compared to women with income not salary-based or no income. Participants dissatisfied with CVR on ≥4 aspects (ambiguity of instructions, inconvenience of use, sensation, sexual discomfort, etc.) were more likely to report non-adherence (PR 2.69, 95% CI=(1.31-5.52)\] compared to those dissatisfied with ≤3 aspects. Non-adherence by residual hormone levels was identified in 46.5% (20/43) participants. Over time, this subset of participants showed increasing non-adherence (*P*=0.004). We found lack of agreement among the various measures of non-adherence. # Conclusions Economic empowerment interventions, especially those emphasizing partner-independent income options, and expanded education on CVR features may alleviate non-adherence. Addressing CVR dissatisfaction preemptively may also help mitigate non-adherence.https://doi.org/10.29392/joghr.2.e2018032 |
| spellingShingle | Eleanor McLellan-Lemal Roman Gvetadze Mitesh A Desai Esther M Makanga Yi Pan Richard E Haaland Angela N Holder Victor Mudhune Tiffany Williams Taraz Samandari Non-adherence among women enrolled in a contraceptive vaginal ring use study in Kisumu, Kenya, 2014-2015 Journal of Global Health Reports |
| title | Non-adherence among women enrolled in a contraceptive vaginal ring use study in Kisumu, Kenya, 2014-2015 |
| title_full | Non-adherence among women enrolled in a contraceptive vaginal ring use study in Kisumu, Kenya, 2014-2015 |
| title_fullStr | Non-adherence among women enrolled in a contraceptive vaginal ring use study in Kisumu, Kenya, 2014-2015 |
| title_full_unstemmed | Non-adherence among women enrolled in a contraceptive vaginal ring use study in Kisumu, Kenya, 2014-2015 |
| title_short | Non-adherence among women enrolled in a contraceptive vaginal ring use study in Kisumu, Kenya, 2014-2015 |
| title_sort | non adherence among women enrolled in a contraceptive vaginal ring use study in kisumu kenya 2014 2015 |
| url | https://doi.org/10.29392/joghr.2.e2018032 |
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